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That is still dealt with by packing an alternative supply of insulin, which is standard advice when using a pump, rather than calling mountain rescue. Day to day I don't carry my insulin pens around with me, but I make darn sure to pack them with spares when on a hike, expedition or camp. And I doubt a diabetic at 11.0 will be incapable of injecting themselves.

Unless the parent is in denial that the pump could fail, at which point, expedition refused unless spare resources are carried, as with any meds such as inhalers or other prescribed drugs.

Since I have experienced a child with no alternative supply, I imagine that you will understand my view on this.

We all agree (I think) that it needs an open and honest discussion with parents and Scout. That the result has to be a suitable backup plan for the pump and that the Scout's peers need to understand what to do if help is needed. If the risk assessment says that the Scout cannot attend then it is sad but safety of the individual has to come first - in my view.

Do NOT administer glucose if sugars are high enough to cause symptoms. I'd be mightily upset of someone offered me glucose when I had high blood sugars.

This is counter to most first aid advice, which is that if the person is not conscious enough to tell you which way they've gone, give sugar anyway, as a hypo could kill/cause severe permanent damage very quickly whereas the damage caused by a hyper (unless they have gone VERY high) is much more long term and not immediate.

The real point here is that if the casualty is conscious listen to them - they know their body.

This is counter to most first aid advice, which is that if the person is not conscious enough to tell you which way they've gone, give sugar anyway, as a hypo could kill/cause severe permanent damage very quickly whereas the damage caused by a hyper (unless they have gone VERY high) is much more long term and not immediate.

The real point here is that if the casualty is conscious listen to them - they know their body.

Wel, from a personal point of view, I know when I have a hypo coming on, it sends me great big flag waving messages, so clear that others can see them too, even if they are unaware that I have diabetes. The Hypo is clear and signals it is coming when bloods get down to about 4.5 through to shaking, cold sweats, hunger and weakness at 3.3 - never knowingly got any lower - and the 3.3 happens during the night. (a quite common occurrence)

A hyper, one that is immediately dangerous as opposed to a medically recorded one happens at the other end of the scale and as far as I am aware, never having had one, thirsty, blurred eyesight, headaches and mood swings ( hang on - maybe I have them all the time). There is no medical advice on NHS or any Diabetes support site that advises giving someone with a blood sugar reading over 11 glucose as a treatment. The serious hyper is said to start at around 15, and if you give me glucose when I am at 15 it will spike my blood sugars to a dangerously high level.

I can recall we had this debate many moons ago on UKRS with Dave Mayall, IIRC, proposing the glucose response at either end of the scale. I wasn't nuts about the idea then, I am not nuts about it now. There are for the diabetes patient, clear indicators and they should be able to advise and act before the hyop or hyper happens. Those around them should also notice and act.
This takes the discussion back to making sure that the participants in the expedition are trained to deal with the scenario of a hyper or hypo and be able to identify it. They will have been in the company of the "patient" and will have an idea what they have eaten or what they have not eaten, what activity they have undertaken. If they are aware of their surroundings and those around them ( and there is a major flaw in this concept) then they will be able to identify a hyper or hypo based on the symptoms displaying and the recent activity/ eating history.

What you need to do ‒ if you’re unsure whether their blood sugar is high or low
If you’re not sure whether someone has high or low blood sugar, give them something sugary anyway, as this will quickly relieve low blood sugar and is unlikely to do harm in cases of high blood sugar

I know - but that does not make it correct (okay, it does not make it correct in every case). In theory, every diabetic should have their test metre with them, so running a test to find out which it is should be a matter of routine, no guesswork required... I often don't have mine with me...

Why do neither the NHS nor Diabetes UK suggest giving someone who may have a hyper glucose? I suspect there is a reason for that.

Let me put it this way. If I have a blood sugar level of 6.5 and I take a single strepsil for a sore throat, within half an hour my blood sugar rises to about 11+ - that with a slow disolving throat sweet. If I were to take a strepsil with my blood sugar at 15, it would spike it at about 21. God alone knows what Glucose would do, and I never want to find out. Note, blood sugar levels that high do make a difference. If someone has been a diabetic for any length of time, they may well have reduced kidney function and spiking blood sugars do damage the kidney. (actually, that's all speculative because my blood sugars can be pretty random - one day a tomato makes no difference, the next day, another tomato from the same vine puts me through the roof).

I know - but that does not make it correct (okay, it does not make it correct in every case). In theory, every diabetic should have their test metre with them, so running a test to find out which it is should be a matter of routine, no guesswork required... I often don't have mine with me...

Why do neither the NHS nor Diabetes UK suggest giving someone who may have a hyper glucose? I suspect there is a reason for that.

So why are they not lobbying SJA (and no doubt the Red Cross as well) to change their teachings?

This is universally taught in First Aid by very reputable organisations. Though do note it's taught as *if you're not sure* - first step should be to ask them.

There is guidance issued by the International Federation of Red Cross and Red Crescent organisations (2016) which says give glucose if unsure of it being hyper or hypoglycaemic. This may be why all UK first aid organisations are following that suggestion. I know other parts of the first aid syllabus have been updated, there may be work underway to update the diabetic guidelines.

So why are they not lobbying SJA (and no doubt the Red Cross as well) to change their teachings?

This is universally taught in First Aid by very reputable organisations. Though do note it's taught as *if you're not sure* - first step should be to ask them.

I will hazard a guess... The First Aider will come upon a scene where he/ she may have no access to the history of the patient, therefore the option is to go for the lesser evil.

It would be interesting to know how many diagnosed diabetic actually suffer from hypos/ hypers without seeing them coming?

I'm guessing that should an incident arise involving a diabetic, I will know what to do, and one way or another there will be a meter available, which is kind of the point, knowing what to do. Second guessing a life changing disease is not a good idea - especially if we are asking kids to do it.

Which going back to the original post emphasises how important it is that the YP communicates and their peers know the symptoms and what to do. Sending them out on an expedition without that is fool hardy at best. Fully support the OP in wanting open, honest communications between all parties.

There is guidance issued by the International Federation of Red Cross and Red Crescent organisations (2016) which says give glucose if unsure of it being hyper or hypoglycaemic. This may be why all UK first aid organisations are following that suggestion. I know other parts of the first aid syllabus have been updated, there may be work underway to update the diabetic guidelines.

How do

I attended yearly first aid courses/refreshers for 30 years whilst employed in an emergency service and almost every year, the guidelines and techniques were updated, based on the most recent medical research and/or experience. Everything was simplified!

An obvious example is CPR, which changed from rescue breaths etc for adults to just chest compressions. The other was the treatment of diabetes. At first we were told how to spot or treat hypo/hyper but over time it became 'if in doubt whack in some sugar and call an ambulance’. I think it unlikely that this will change back to what was found to be 'complicated' in first aid terms, unless medical opinion changes due to an increase in harm done. But as others have already pointed out, this is first aid with no medical history.

The explorer’s condition is known. Perhaps the diagnosis is recent and the mother is still ‘grieving’, hence her reluctance to engage fully? The Explorer may also be reluctant to share, as the diagnosis can can hit teenagers hard. It can also be the cause of some embarrassment to them. This might explain the four hours sorting it out with no one told. You have already accepted the condition without giving it a second thought (entirely natural, right and proper) - as will the other Explorers - and just want to manage any risk. It may take them a little longer.